title: Giant prolactinomas in women.
abstract: OBJECTIVE
  To characterise distinctive clinical features of giant prolactinomas in women.
  
  
  METHODS
  A multicentre, retrospective case series and literature review.
  
  
  METHODS
  We collected data from 15 female patients with a pituitary tumour larger than 4 cm and prolactin levels above 1000 μg/l and identified 19 similar cases from the literature; a gender-based comparison of the frequency and age distribution was obtained from a literature review.
  
  
  RESULTS
  The initial PubMed search using the term 'giant prolactinomas' identified 125 patients (13 women) responding to the inclusion criteria. The female:male ratio was 1:9. Another six female patients were found by extending the literature search, while our own series added 15 patients. The median age at diagnosis was 44 years in women compared with 35 years in men (P<0.05). All cases diagnosed before the age of 15 years were boys. In women (n=34), we observed a minor peak incidence during the third decade of life and a major peak during the fifth decade. Amenorrhoea was a constant feature with seven cases of primary amenorrhoea. In eight women with onset of secondary amenorrhoea before the age of 40 years, the diagnosis was made 2-31 years later (median 9 years) and in all but one because of tumour pressure symptoms. The prolactin levels were above 10,000 μg/l in 15/34 and misdiagnosis due to 'hook effect' occurred in two of them. Eighteen patients were treated with cabergoline; standard doses (<2.0 mg/week) were able to normalise prolactin in only 4/18 patients, and 7/18 patients were resistant to weekly doses ranging from 3.0 to 7.0 mg.
  
  
  CONCLUSIONS
  Giant prolactinomas are rare in women, often resistant to dopamine agonists and seem to be distributed in two age groups, with a larger late-onset peak.
authors.affiliation: Service d'Endocrinologie, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, B-5530 Mont-sur-Meuse, Belgium.
authors.forename: Etienne
authors.initials: E
authors.lastname: Delgrange
authors.forename: Gerald
authors.initials: G
authors.lastname: Raverot
authors.forename: Marie
authors.initials: M
authors.lastname: Bex
authors.forename: Pia
authors.initials: P
authors.lastname: Burman
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Decoudier
authors.forename: France
authors.initials: F
authors.lastname: Devuyst
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.forename: Marianne
authors.initials: M
authors.lastname: Andersen
authors.forename: Dominique
authors.initials: D
authors.lastname: Maiter
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000568:Amenorrhea / Q000209:etiology / Q000517:prevention & control; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006966:Hyperprolactinemia / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D010902:Pituitary Gland / Q000187:drug effects / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D018491:Dopamine Agonists; D011388:Prolactin